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' . <br /> City of Orono <br /> Building Permit Appiication <br /> for New Structures or Additions <br /> Mailing Address: .; . ; �:_ : ' "=:,�""'? <br /> .�Q A TO PO Box 66 Permit number: � , � .� � <br /> `V Crystal Bay, MN 55323-0066 Date received: �_'/ '1, ! ` <br /> Received b �-�-,<' ��/�r�` <br /> Street Address:' - � Y� _— <br /> a �- 2750 Kelley Parkwa #, . , '� ! �l "• "' � <br /> - Plan review fee: ` � -� " -'f'i�'� ��-�`��� = <br /> y� �, ti:��✓y l':(� �G 1� � ., _ � _ _r ,'' <br /> c,` Orono, MN 55356 � ' <br /> l�kfSHOQ'� Main: 952-259-4600 Total Fee: <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form must be completed in full and ail required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: � <br /> Job Site Address: � � l�� "� �.,G� e r�� �?t`��'1G ►`��`� �`� ��`� <br /> Will this be a Parade of Homes, Rem elers Showcase Home or other Dispiay Home? ❑ Yes No <br /> If yes, a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service ill be <br /> required un/ess applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# Expiration Date: <br /> Phone: (cell) (office) <br /> Mailing Address: City: ZIP: <br /> Contact Person: Applicant is: Contractor / Homeowner (Circle One) <br /> Email and/or Fax: <br /> PROPERTY OWNER INF RMATION: � { j_- L <br /> Name: ` :.�I'7 ��. '�` `J IL� �."�Y1���--' <br /> Phone (day): �'_ .' - %3 �-' <br /> Address: " > �r;:. � �• Cit : ��1�1� ZIP: ��.��J�� <br /> Emaii and/or Fax ' � � � � c�j . ��,-t��� <br /> ARCHITECT/ ENGINEER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Address: City: ZIP: _ _ <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Description of project: <br /> 1.Type of Project 2. Proposed Use 3. Structure Type � 4. Sewage Disposal & <br /> Water Supply <br /> ❑ New Construction ❑ Single Family with ❑ Residence <br /> ❑Addition attached garage ❑ Garage/Accessory Bldg. ❑ Public Sewer <br /> [y�'Accessory Building ❑ Single Family with ❑ Deck • <br /> ❑ Relocation detached garage ❑ Office/Commercial �Private Sewer <br /> ❑ Other: (specify) ❑ Multiple Family/Condo ❑ Warehouse j� <br /> ❑ Public �Storage ,-� `-�?�`�` ❑ Public Water <br /> *"Any earth movement may require ❑ Commercial ❑ Other(specify) <br /> MCWD review& permits. ❑ Industrial �Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (Specify) <br /> 18202 Minnetonka Blvd <br /> Deephaven, MN 55391 <br /> Phone: 952-471-0590 <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or <br /> / (I'�•J <br /> Estimated Construction Valuation (excluding land) �.��� . <br /> Packet Last Updated. 04/19/2013 <br /> Page 22 of 23 <br />